Citric acid/chitosan adhesive with viscosity-controlled for wood bonding through supramolecular self-assembly.

Developing bio-based sustainable wood adhesives is significant as a substitute for petroleum-derived adhesives. However, the existing bio-based adhesives have disadvantages of complex fabrication, uncontrollable viscosity, and poor water resistance. Herein, we developed a citric acid/chitosan adhesive with viscosity-controlled and water-resistant features by one-step dissolution at room temperature based on the supramolecular self-assembly strategy. Different wood products (plywood, laminated veneer lumber and particleboard) with superior performance were prepared by applying that adhesive on veneer and wood particles (fine and rough particles). The plywood test results showed that the citric acid/chitosan adhesive had dry and wet shear strengths outperforming the China National Standard (GB/T 9846-2015, ≥0.7 MPa), reaching 2.1 and 1.1 MPa, respectively. The adhesion mechanism was mechanical interlocks and cross-linking of citric acid/chitosan in adhesives with those in the cell wall. This work provides high promise for alternatives to traditional unsustainable wood adhesives (urea-formaldehyde, melamine-urea-formaldehyde and phenolic resins) for fabricating different wood products.

Ginseng-Astragalus-oxymatrine injection ameliorates cyclophosphamide-induced immunosuppression in mice and enhances the immune activity of RAW264.7 cells.

ETHNOPHARMACOLOGICAL SIGNIFICANCE: Ginseng quinquefolium (L.), Astragalus membranaceus, and Sophora flavescens Aiton are popular folk medicines in many Asian countries and regions. These three traditional Chinese herbs and their extracts have been reported to considerably enhance the immune function. G. quinquefolium (L.) is considered the king of herbs in China. Traditionally, G. quinquefolium (L.) is believed to replenish vitality, which is considered as immune enhancement in modern Chinese pharmacy. One of the main uses of Astragalus is immunity enhancement; S. flavescens and oxymatrine obtained from its extract have been used to treat leukopenia. Considering the pharmacological properties of Ginseng, Astragalus, and oxymatrine, we evaluated the immunopotentiation effects of their combination, Ginseng-Astragalus-oxymatrine (GAO), in the present study. AIM OF THE STUDY: This study aimed to expand the clinical application of GAO and to preliminarily explore its mechanism of action by determining whether GAO injection can enhance immunity in vivo and in vitro. METHODS: Overall, 17 major chemical components in GAO were analysed using HPLC and LC-MS. The immunity-enhancing effect of GAO was studied in the cyclophosphamide (CTX)-induced immunosuppressive mouse model and RAW 264.7 cells. RESULTS: Quantitative analysis showed that the potential active components of GAO include at least ginsenosides, astragaloside IV, and oxymatrine. GAO could significantly improve the nonspecific immunity including the indices of the thymus and spleen, number of peripheral blood leukocytes, levels of TNF-α and IL-6, phagocytic function of macrophages, and cytotoxic activity of natural killer (NK) cells. Additionally, GAO enhanced the humoural immunity, characterised by the antibody production ability of B cells, and cellular immunity, characterised by the activity of T cells, in immunosuppressed mouse. Moreover, GAO could enhance the phagocytic and adhesion functions of RAW 264.7 cells, which may be related to the activation of reactive oxygen species and NF-κB signalling pathway. CONCLUSION: GAO could dramatically ameliorate CTX-induced immunosuppression in mouse and stimulate the immune activity in RAW 264.7 cells possibly by activating the NF-κB signalling pathway.

Strategies that facilitated expansion of a postgraduate year 1 pharmacy residency program across a community hospital-based health system.

PURPOSE: Seven strategies used to expand an existing postgraduate year 1 (PGY1) pharmacy residency program and launch 3 new PGY1 residency programs in a multisite community hospital-based health system are described. SUMMARY: The vision of ASHP and other pharmacy organizations of providing advanced training (e.g., residency training) to all pharmacists who plan to be involved in direct patient care has not yet been realized, and the capacity to provide such training has not kept pace with the demand. Wheaton Franciscan Healthcare (WFH) leaders expanded PGY1 residency training and recognized 7 strategies that enabled program growth at multiple sites within the healthcare system. WFH pharmacy leaders were charged to (1) take a bold approach to expansion of residency training, (2) place the residency program at the center of pharmacy department operations, (3) develop teams of high-performing preceptors, (4) partner with schools of pharmacy, (5) initiate rotations at other facilities within the healthcare system, (6) elevate resident ownership of and engagement in the residency program, and (7) enhance communication and collaboration across the program. As a result of these strategies, a single residency program with 2 residents was expanded in a 4-year time frame to encompass 4 programs with a total of 14 residents. CONCLUSION: Seven strategies facilitated the expansion of 1 pharmacy residency program and the successful launch of 3 new PGY1 residency programs across the WFH system. These strategies provide a basic framework for both residency training expansion and clinical service development.

Allergic shock and death associated with protamine administration in a diabetic patient.

BACKGROUND: Insulin is used to treat patients with both type 1 and type 2 diabetes mellitus. Allergic reactions to insulin might be triggered by insulin itself or inactive ingredients in the insulin formulation, including proteins such as protamine in neutral protamine Hagedorn (NPH) insulin. The use of highly purified animal insulin and human recombinant insulin has reduced the incidence of anaphylactic reactions to insulin from ~30% to <1%. OBJECTIVE: We report a case of fatal allergic shock after the administration of protamine in a patient with a history of allergy to fish and a protamine-containing insulin. CASE SUMMARY: A 72-year-old Chinese male patient (height, 175 cm; weight, 80 kg) with a history of diabetes and progressive limb weakness was diagnosed with spinal vascular malformations after admission to the Xuan Wu Hospital of Capital Medical University, Beijing, People's Republic of China. He underwent epidural spinal cord arteriovenous fistula embolization with a liquid embolic agent (ethylene vinyl alcohol copolymer) after spinal cord angiography. During the operation, heparin was infused every hour with 6250, 2500, 2500, and 1250 IU, respectively. The last dose of heparin was administered ~10 minutes before the operation was completed. This was followed by the administration of protamine to neutralize the remaining heparin in the patient's body. Blurry vision and dizziness 5 minutes after protamine administration were followed by pruritus and hives over his neck and face. Oxygen was administered and 10 mg of dexamethasone with 2 mg of epinephrine was injected. The patient's heart rate dropped, his blood pressure decreased, and his arterial oxygen saturation (SaO2) declined progressively. About 10 minutes after the administration of protamine sulfate, the patient developed bradycardic arrest. Cardiopulmonary resuscitation efforts were undertaken and the patient was administered epinephrine 2 mg IV, atropine 0.5 mg IV, and subsequently, intravenous dopamine (50 mg/h). Ten minutes later, the patient's heart rate gradually increased, but blood pressure fluctuated, and SaO2 ranged from 90% to 100%. Despite the initial response, the patient lost consciousness and heart rate declined progressively within 5 hours. Vasoactive agents including dopamine, norepinephrine, and adrenaline were administered. After all these measures proved ineffectual, the patient died. It was later determined that the patient had a history of allergic reactions to fish as well as to a premixed insulin that contained soluble human insulin 30% and low-protein intensive insulin zinc 70% (NPH). The Naranjo adverse drug reaction probability scale score for the association of protamine with the allergic reaction was 4, suggesting a possible relationship. CONCLUSION: This case report highlights a preventable fatal allergic reaction possibly associated with protamine administration in a patient with a history of allergy to a protamine-containing insulin.